Welcome, members of the 119th Congress. You have a tremendous opportunity to bring meaningful and long-overdue changes to health care that will better support physicians, remove barriers for patients, and improve access to care for millions of your constituents.
To get the 119th off to a good start and show that you can accomplish what the 118th could not, you should expedite passage of meaningful legislation that enjoys bipartisan support:
- Reverse the 2.8% Medicare cuts that began on Jan. 1 and enact a sustainable Medicare payment model that supports thriving independent physician practices.
- Reform the onerous prior authorization process in Medicare Advantage.
- Extend telehealth flexibilities.
It’s time to get these done.
Prior auth accountability, transparency
We were close to achieving these reforms last fall. A legislative fix known as the Improving Seniors’ Timely Access to Care Act that would alleviate some of our prior authorization headaches drew broad support on both sides of the aisle. A majority of House members—139 Democrats and 89 Republicans—signed on as co-sponsors and sent a clear signal that this vitally important reform deserves passage. A companion bill in the Senate also earned bipartisan sponsorship and support from a majority of Senators.
Lawmakers on both sides clearly recognize the pressing need to reduce the prior authorization burden. The bipartisan and bicameral support evidenced to date demonstrates the need for a commonsense solution that needs to become law.
That need has never been clearer to the AMA, to our partners in the Federation of Medicine, and to the hundreds of health care organizations that continue to urge Congress to act decisively on this issue. My fellow physicians and I encounter the wasteful, harmful and in some cases fatal consequences of the prior authorization-based treatment roadblocks that payers place in our way on a daily basis. Patients are beyond disappointed with insurers declaring record profits while delaying and denying needed care
Denials are often issued without explanation or justification, with no information on how the decision can be appealed, and with no guidance whatsoever on alternative treatment options. Physicians and their patients are left in the dark, with adverse outcomes for patients too often the result.
The lack of transparency that permeates the prior authorization process is maddening, but even more dangerous is the harm our patients face when treatment is delayed or denied outright. Their conditions worsen, and the results can be devastating when patients decide to abandon the care they need but cannot obtain. AMA survey research shows that more than 90% of physicians report prior authorization negatively affects clinical outcomes for their patients.
The final rule issued last year by the Centers for Medicare & Medicaid Services was a welcome step toward rightsizing the prior authorization process imposed on medical services and procedures by Medicare Advantage and other government-regulated plans. This rule will reduce patient-care delays as well as the administrative burdens long shouldered by physicians.
These are not extremist measures, but rather are based upon reforms that reflect principles that representatives of the insurance industry agreed to back in 2018. Unfortunately, six years later they have still not lived up to their commitment. Now it is time for Congress to protect at least our most vulnerable patients—the seniors and disabled individuals on Medicare and Medicare Advantage plans.
You can learn more about the efforts to achieve reform and share your own experiences at FixPriorAuth.org.
Medicare payment reform
Patients and physicians watched with deep concern as the 118th Congress adjourned in December without fixing the broken Medicare payment formula and allowing a 2.83% cut to take effect. This marks the fifth straight year that payments to physician practices have been cut, despite the inflation we have all experienced during these years.
Medicare physician payment rates, when adjusted for the costs of running a practice, have fallen by 33% over the past two decades (JPG), and left physicians struggling to figure out how they can continue to provide needed care to their elderly and chronically ill patients. Now the 119th Congress must act to reverse this cut and enact a new payment formula based upon the ever-increasing cost of providing care.
As with prior authorization reform, fixing the broken Medicare system enjoys bipartisan support in Congress. The time is now to enact targeted reforms to statutory budget neutrality requirements and provide physicians with a payment update that reflects inflationary pressure. Again, this is not a radical idea. In fact, hospitals, long-term care facilities, and others already get an annual update based upon inflation. This legislation would simply put those who actually provide care to patients, namely physicians, on equal footing.
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Extending telehealth’s reach
Telehealth was a literal lifeline for patients during the COVID-19 public health emergency, ensuring access to a physician’s care without the risks of leaving home. This was only possible because Congress acted quickly to implement legislative and regulatory flexibilities that broadened the reach of remote patient care to benefit patients in rural and underserved areas.
We must make these flexibilities permanent and secure telehealth’s future as an essential element of our patient toolbox, and ensure that all Americans—including rural, underserved, and historically marginalized populations—can receive full access to the care they need.
Congressional action is required to prevent the severe limitations on telehealth that existed before the COVID-19 pandemic from being restored. Before the latest government-funding agreement expires on March 31, the 119th Congress should pass a permanent extension of the telehealth flexibilities that have saved so many lives.
Action on other fronts
Similarly, the important gains our nation has made by providing more people with health coverage in the past decade have saved countless lives and reduced suffering. These gains have also demonstrated the importance of policies implemented at the federal level to make private marketplace coverage more affordable, to improve access to care across both private and public health plans, and to provide additional public health funding.
The AMA has a vision on health reform that will guide future advocacy to improve our nation’s health system. This starts with the Medicare physician payment reform so desperately needed to ensure the viability of physician practice and patient access to care.
The AMA and our Federation of Medicine partners remain firmly committed to working with the new Congress, the new administration and all other stakeholders to create and sustain a health system that best serves patients and physicians through reduced regulatory burdens, greater cost transparency and affordability, physician-led payment reform and commonsense medical liability measures, among other objectives.
All these goals and more are within our reach if we act on our collective will to achieve them. We look forward to seeing the actions of the 119th Congress to put our health care system on the right track.
